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Context: This study aimed to know the clinical and demographic profile of pediatric cataracts in Oman., Aims: The aim of this study was to describe the demographic and clinical profile of pediatric cataracts in a tertiary care hospital, Oman., Settings and Design: This was a hospital-based, retrospective observational study., Subjects and Methods: A retrospective cross-sectional study of all Omani children presented to ophthalmology outpatient at a tertiary hospital, between January 2012 and December 2016. All patients aged <18 years presented with lens opacity were included in the study. Traumatic cataract cases were excluded from the study., Statistical Analysis Used: SPSS version 22.0 International Business Machines, (Armonk, New York, Unites States of America, dated 8/13/13) used for statistical analysis., Results: Among 379 eyes of 239 patients, 58.6% (140 patients) had bilateral cataracts. Male-to-female ratio was 1.38:1. We arrived at prevalence of 4.32 with 95% confidence interval (3.85, 4.77) of congenital cataract cases/10,000 Omani Children. Most patients (54%) were from either Muscat (28.9%) or A'Sharqiyah (25.1%). The median age of cataracts first noticed by parents was 3 months and the median age of presentation to the eye care unit was 15 months. Patients with positive family history significantly ( P = 0.007) presented with bilateral cataracts (75%). About 22.2% of the patients had associated systemic diseases. Among those with systemic association, 77.4% of cases had bilateral cataracts. About 35.4% of eyes had another ocular association. The most common ocular association was squint (11.1%). The most common cataract morphologies at presentation were 20.1% presenting with total lens opacities and 19.8% with posterior subcapsular/posterior lenticonus., Conclusions: A higher demographic distribution of pediatric cataracts was found in Muscat governorate. There was a significant median delay in presentation to the pediatric ophthalmology clinic by 12 months since lens opacity was first noticed by parents., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Oman Ophthalmic Society.)

Objectives: Disagreement between health care providers on medication-related interventions can affect clinical outcomes. We aimed to study the outcomes and significance of clinical pharmacists' interventions and evaluate the levels of agreement between different clinical pharmacists on the impact of pharmaceutical interventions., Methodology: A retrospective study was conducted at a tertiary care hospital in Oman. The study included all documented interventions by clinical pharmacists for all categories of admitted patients that met the inclusion criteria., Results: The originator clinical pharmacists interjected to improve the efficacy of treatment in (58%, n=1740) of the interventions, followed by toxicity reduction (24%). The level of agreement in the clinical significance resulted in substantial Scotts' kappa (k) between the originator and the first reviewer, the first and second reviewers, and the second reviewer and supervisor (86%; k=0.77; P<.001), (77%; k=0.63; P<.001), (84%; k=0.77; P<.001), respectively. In terms of grading of clinical significance, the originator clinical pharmacists recorded moderate significance in 50% of the interventions, followed by major (30%), not applicable (8.4%), and minor (7.3%). The level of agreement in the clinical significance resulted in substantial Scotts' k between the originator and the first reviewer, and between the second reviewer and supervisor (82%; k=0.72; P<.001), (84%; k=0.77; P<.001), respectively. The level of agreement between the first and second reviewer was fair (55%; k=0.28; p<0.001)., Conclusion: Clinical pharmacists' interventions have a crucial impact on patient safety, improving efficacy and reducing toxicities. Overall, there was a substantial agreement among clinical pharmacists on the clinical significance and grading of the interventions.., (Copyright: © Pharmacy Practice.)

Objectives: Amblyopia, strabismus and ocular motility disorders are common conditions with significant impact on visual function, appearance and quality of life. We aimed to establish a core set of outcomes for each of the three conditions for use in clinical trials and routine clinical practice., Design: A comprehensive databank of outcomes was developed from a systematic review of the literature and a series of focus groups with healthcare professionals, researchers, patients and carers. The databank of outcomes was scored in a two-round Delphi Survey completed by two stakeholder groups: healthcare professionals/researchers and patients/carers. Results of the online Delphi were discussed at a face-to-face consensus meeting where the core outcome sets were finalised., Setting: UK-wide consultation., Participants: Researchers, clinicians, patients and carers., Outcome Measures: Core outcome sets., Results: For amblyopia, strabismus and ocular motility, 40/42/33 participants contributed to both rounds of the Delphi; six/nine/seven members attended consensus meetings, respectively. Consensus was reached on ten core outcomes for both amblyopia and ocular motility and nine for strabismus. All three conditions shared the core outcomes: adverse events, cost, vision-related quality of life and ocular alignment . The strabismus and ocular motility disorder core sets included, in addition, measuring the deviation, binocular vision, ocular movement, patient satisfaction and symptoms . The amblyopia set, distinct from the sets for the other two conditions, included best corrected distance and near visual acuity, spherical and cylindrical refraction, compliance and treatment-related and functionality/long-term impacts ., Conclusions: The study used robust consensus methods to develop a core outcome set for three ophthalmic conditions. Implementation of these core outcome sets in clinical trials and routine clinical practice will ensure that the outcomes being measured and reported are relevant to all stakeholders. This will enhance the relevance of study findings and enable comparison of results from different studies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: The aim of this study was to evaluate the progression of tricuspid regurgitation (TR) in patients with pacemaker leads across the tricuspid valve and assess the clinical effect on right ventricular (RV) function., Methods: Patients who had undergone permanent pacemaker implantation at our institution over an 8-year period were identified. Those who had an echo (for any indication) pre- and postdevice implantation were included in this study, and their data assessed. Clinical information was obtained from their medical records. A total of 65 patients (mean age 70 ± 13 years, 31 (48%) males, and 34 (52%) females) were enrolled in the study., Results: The median interval of echo after implantation was 12 (12 to 24) months. Before implantation, 29 patients had TR, which increased to 51 (78%) during follow up, indicating that 22 patients developed new TR. Of those with preexisting TR, the grade of TR had worsened by at least one grade in 17 patients. RV function as measured by tricuspid annular plane systolic excursion (TAPSE) had decreased from 1.87 ± 0.44 to 1.68 ± 0.42 ( p  = 0.002). Eighteen patients had developed signs of right heart failure (either breathlessness with raised jugular venous pressure or pedal edema or both), of which 13 had only new pedal edema., Conclusion: There is a definite progression of TR in patients with a pacing lead across the tricuspid valve (TV) associated with an increase in the incidence of right heart failure. Patients with a pacing lead across the TV should be followed closely for signs of right heart failure., (© 2020 Nadar, Shaikh, Jabri, Rawahi, licensee HBKU Press.)

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Background: Core Outcome Sets (COS) are defined as the minimum sets of outcomes that should be measured and reported in all randomised controlled trials to facilitate combination and comparability of research. The aim of this review is to produce an item bank of previously reported outcome measures from published studies in amblyopia, strabismus and ocular motility disorders to initiate the development of COS., Methods: A review was conducted to identify articles reporting outcome measures for amblyopia, strabismus and ocular motility disorders. Using systematic methods according to the COMET handbook we searched key electronic bibliographic databases from 1st January 2011 to 27th September 2016 using MESH terms and alternatives indicating the different subtypes of amblyopia, strabismus and ocular motility disorders in relation to treatment outcomes and all synonyms. We included Cochrane reviews, other systematic reviews, controlled trials, non-systematic reviews and retrospective studies. Data was extracted to tabulate demographics of included studies, primary and secondary outcomes, methods of measurement and their time points., Results: A total of 142 studies were included; 42 in amblyopia, 33 in strabismus, and 68 in ocular motility disorders (one study overlap between amblyopia and strabismus). We identified ten main outcome measure domains for amblyopia, 14 for strabismus, and ten common "visual or motility" outcome measure domains for ocular motility disorders. Within the domains, we found variable nomenclature being used and diversity in methods and timings of measurements., Conclusion: This review highlights discrepancies in outcome measure reporting within published literature for amblyopia, strabismus and ocular motility and it generated an item bank of the most commonly used and reported outcome measures for each of the three conditions from recent literature to start the process of COS development. Consensus among all stakeholders including patients and professionals is recommended to establish a useful COS.

Introduction: Gallbladder duplication is a rare congenital anomaly. Recognition of this anomaly and its various types is important since it can complicate a simple hepatobiliary surgical procedure., Presentation of Case: We report a case of a 42 year old female who presented a 6 year history of intermittent right upper quadrant abdominal pain. Her basic blood investigations including liver function tests were normal. Pre-operative imaging revealed a cystic lesion communicating with biliary tree representing duplicated gallbladder. She subsequently underwent successful laparoscopic cholecystectomy. The operative challenges were more than those anticipated at the usual laparoscopic gallbladder procedures. After six months follow up the patient remained asymptomatic., Discussion: Preoperative diagnosis plays a crucial role in planning surgery, and preventing possible biliary injuries or re-operation if accessory gallbladder has been overlooked during initial surgery. Magnetic resonance cholangiopancreatography (MRCP) is the imaging modality of choice for suspected duplicate gallbladder. Laparoscopic cholecystectomy for duplicate gallbladder is a challenging operation and should be performed with meticulous dissection of the cysto-hepatic triangle., Conclusion: Gallbladder anomalies should be anticipated in the presence of a cystic lesion reported around the gallbladder. The laparoscopic cholecystectomy remains feasible for intervention and should be done by an experienced laparoscopic surgeon., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Ocular ischaemic syndrome (OIS) is a relatively uncommon condition. Simultaneous bilateral involvement is even less common and has been reported in only 22% of all cases of OIS. It has variable clinical presentations, of which visual loss and ocular pain are the most common. It is believed to occur when there is a 90% or greater carotid artery obstruction. This syndrome is often associated with a number of systemic diseases including diabetes mellitus, hypertension, coronary artery disease, and cerebrovascular disease. Only occasionally has it been described as a complication of rhinocerebral mucormycosis. We report an unusual case of bilateral OIS secondary to bilateral internal carotid artery thrombosis as a complication of invasive rhinocerebral mucormycosis. In addition, a review of clinical presentation, diagnostic work-up and treatment options for OIS is provided.

Purpose: To investigate the efficacy and safety of oral propranolol in the management of periorbital infantile hemangioma in four subjects., Materials and Methods: Consecutive patients who presented with periorbital capillary hemangioma with vision-threatening lesions were prospectively enrolled in this study between January 2009 and October 2010. All subjects underwent treatment with 2 mg/kg/day oral propranolol. All subjects underwent ocular, systemic, and radiologic evaluations before treatment and at periodic intervals after starting therapy. Side effects from therapy were also evaluated., Results: Four subjects, between 3 months and 19 months of age, with periorbital hemangioma were enrolled in this study. Two subjects had been previously treated with oral corticosteroids with unsatisfactory response. All subjects had severe ptosis, with the potential for deprivation amblyopia. Three subjects had orbital involvement. After hospital admission, oral propranolol was initiated in all subjects under monitoring by a pediatric cardiologist. Subsequent therapy was performed with periodic out-patient monitoring. All subjects had excellent response to treatment, with regression of periorbital and orbital hemangioma. There were no side effects from therapy., Conclusions: Oral propranolol for periorbital hemangioma was effective in all the four subjects. Oral propranolol may be appropriate for patients who are nonresponsive to intralesional or systemic steroids. In patients with significant orbital involvement and lesions causing vision-threatening complications, oral propranolol can be the primary therapy.

Postsurgical adhesion formation is an important clinical problem within all surgical specialties. In gynecology, adhesions resulting from gynecologic procedures are a major clinical, social, and economic concern because they may result in pelvic pain, infertility, or bowel obstruction. In addition, it may lead to additional surgery to resolve the adhesion-related complications. This review evaluates the available evidence regarding the effectiveness of various strategies for reducing postsurgical adhesions. Those strategies include surgical techniques and adhesion-reducing substances. Postsurgical adhesions are natural consequences of tissue trauma and healing. Our review indicates that most of the effective adhesion-reducing substances decrease adhesion formation and reformation, but they do not prevent its occurrence. In fact, there is no single modality proven to be unequivocally effective in preventing adhesion formation. Current evidence suggests that the use of ORC (Interceed; Gynecare, Somerville, NJ), e-PTFE (Gore-Tex Surgical Membrane, Preclude; WL Gore, Flagstaff, AZ), HA-CMC (Seprafilm; Genzyme, Cambridge, MA), or 4% icodextrin (Adept; Baxter BioSurgery, Deerfield, IL) is justified. Their use, however, should not replace good surgical techniques. We recommend the use of microsurgical principles, minimally invasive surgery, and the use of adhesion-reducing agents., (© Thieme Medical Publishers.)

Resource: The subclinical rejection is defined as finding of histological signs of rejection on well functioning grafts. Its diagnostic domain remains protocol biopsy. The diagnostic value of ultrasound scaning in subclinical rejection has not been studied yet., Aim: The aim of our study was to detect the incidence of subclinical rejection in protocol biopsies in the first three months after kidney transplantation and to find out the ultrasound correlation to histological picture of subclinical rejection with special accent on ultrasound signs of parenchymal oedema, quantity and quality of perfusion emphasising their changes in process of time., Methods: Sixty six protocol graft biopsies were performed on 36 recipients of cadaveric renal transplants in Transplant Centrum Olomouc between July 1999 and September 2000. The biopsies were carried out 21 +/- 2 days and 90 +/- 5 days after transplantation. Subclinical rejection was defined as t2 i2 v0 (IA) rejection infiltrate by Banff 97 histological classification at the same time with serum creatinine in normal range and ultrasound signs of parenchymal oedema., Results: In the group of subclinical rejection the ultrasound findings of graft parenchymal oedema correlated with 81% sensitivity and 90 % specificity with histological diagnosis. The duplex picture of parenchymal hyperaemia blush - had 100 % specificity but low sensitivity. The resistive indices were in the wide range 0,61 - 0,80 without diagnostic value., Conclusion: The high sensitivity and specificity of ultrasound prospective follow up was found in the subclinical rejection diagnosis. Parenchymal hyperaemia indicated high specificity but low sensitivity in evaluation of subclinical rejection. No benefit of resistive indices was found. Larger sample of patients has to be established to gain more exact review anyway.